NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE

- NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE

AFP ID APPLICATION FORM (FOR DEPENDENT)

This form is NOT FOR SALE. Report anyone selling this form to OTAG CP# 0946-481-8147 / 0975-795-6561
DEPENDENT ACTIVE DEPENDENT RETIRED SERIES: 04-0219-V.02
OFFICER OFFICER SON & DAUGHTER
EP EP LEGAL BENEFICIARY

FIRST NAME PASTE Recent (15 day old) 2x2

colored picture in formal/semi-
MIDDLE NAME formal attire with white
background in proper haircut,
LAST NAME no mustache/beard, and no
eye glasses.
HOME
ADDRESS
CONTACT NR
BIRTHDATE - - RELATIONSHIP TO THE MILITARY PERSONNEL
ex: 11-Mar-1980 day month year

MARITAL STATUS: SINGLE MARRIED WIDOW / WIDOWER SEPARATED (By court order) ANNULLED

WEIGHT(Kgs) HEIGHT(cms) BLOOD TYPE GENDER MALE FEMALE

COLOR OF EYES COLOR OF HAIR RELIGION

NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE

PHIL HEALTH NO. TIN

GSIS
MILITARY PERSONNEL DATA RANK BRSVC
FIRST NAME
MIDDLE NAME
LAST NAME
ETAD / ETE / RE-ENLISTMENT / DATE RETIREMENT - -
ex: 11-Mar-1980 day month year
AFPSN RIGHT THUMBMARK

NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE

Statement of Consent
I declare that I am fully aware that the above data shall be used for securing my AFP
Identification Card Number (AFPIC Nr) for the AFP Identification Card System or updating my
personal data and that it shall form part of the AFPICS Registry. I trust that the above data shall
remain confidential hence I give my consent that the same data be secured and accessed for
subsequent validation, verification, and other purposes consistent with the objectives of the
AFPIC System under Executive Order No. 420 only. I further affirm that all statements/data,
which appear in this registration form and made by me are true and complete to the best of my
knowledge and belief.

DATE SIGNED SIGNATURE OVER PRINTED NAME AFFIX SIGNATURE INSIDE THE BOX
(PIRMA SA LOOB NG KAHON)

APPROVED BY:
SIGNATURE OVER PRINTED NAME VALIDATED BY: ENCODED BY:

RANK BRSVC
BIO BY: PRINTED BY:
UNIT ADJ / ADMIN OFFICER
OTAG COPY CLIENT COPY
DATE RELEASE: DATE RELEASE:
FULL NAME OF ID APPLICANT FULL NAME OF ID APPLICANT

NAME OF REPRESENTATIVE AND RELATIONSHIP TO THE APPLICANT NAME OF REPRESENTATIVE AND RELATIONSHIP TO THE APPLICANT

CASHIER'S NAME AND SIGNATURE: CASHIER'S NAME AND SIGNATURE:

NOT PAID PAID BALANCE: NOT PAID PAID BALANCE:

NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE - NOT FOR SALE
 REQUIREMENTS
LEGAL BENEFICIARY
1) Duly accomplished application form.
2) Authenticated copy (in original mark) of “Declaration of Legal Beneficiaries” from JAGO (GHQ/PGMC,
ARMY, NAVY, AIR FORCE).
3) ORDERS: Authenticated copy (in original mark) of Retirement/Separation/Posthumous and
Amendment Orders from NRD, OTAG and Major Service Adjutant (ARMY, NAVY, AIR FORCE).
4) SPOUSE (WIFE/HUSBAND): Original copy of NSO/PSA Marriage Contract;
Latest and Original copy of PSA CRS Form-4 CENOMAR / PSA CRS Form-5 Advisory on Marriages for
applicants below 60 years old;
CHILDREN: Original copy of NSO/PSA Birth Certificate;
BROTHERS/SISTERS: Latest and Original copy of PSA CRS Form-4 CENOMAR / PSA CRS Form-5
Advisory on Marriages;
PARENTS: Original copy of NSO/PSA Birth Certificate of the deceased military personnel;
5) Original copy of LCR/NSO/PSA Death Certificate.
6) Surrender old AFP ID, if lost, attached AFFIDAVIT OF LOSS and POLICE BLOTTER.
If lost ID is recently issued, it will be replaced a month after filing for evaluation.
If Applicant is NON-APPEARANCE additional
7) Special Power of Attorney (must be immediate family of the pensioner)
8) Proof of Life: Whole body picture (postcard size) holding the front page of latest newspaper (15 days
old); Include the front page of the newspaper.
If Applicant LIVING ABROAD additional
9) Photocopy of Valid Passport.
10) Acknowledgement from the Consulate General from the country he/she is staying.
DEPENDENT OF RETIRED MILITARY
1) Duly accomplished application form.
2) WIFE/HUSBAND: Original copy of NSO/PSA Marriage Contract;
Latest and Original copy of PSA CRS Form-4 CENOMAR / CRS Form-5 (if needed);
CHILDREN: Original copy of NSO/PSA Birth Certificate;
PARENTS: (indigent parents 60 years of age and above) Original copy of NSO/PSA Birth Certificate of
active military personnel.
3) ORDERS: Authenticated copy (in original mark) of Retirement Order.
4) Surrender old AFP ID, if lost, attached AFFIDAVIT OF LOSS and POLICE BLOTTER.
If lost ID is recently issued, it will be replaced a month after filing for evaluation.
DEPENDENT OF ACTIVE OFFICER/ENLISTED PERSONNEL AND RESERVIST W/ ADT/AADT
1) Duly accomplished application form.
2) WIFE/HUSBAND: Original copy of NSO/PSA Marriage Contract;
Latest and Original copy of PSA CRS Form-4 CENOMAR / PSA CRS Form-5 (if needed);
CHILDREN: Original copy of NSO/PSA Birth Certificate;
PARENTS: (indigent parents 60 years of age and above) Original copy of NSO/PSA Birth Certificate of
active military personnel.
3) ORDERS: Authenticated copy (in original mark) of Promotion/ETAD/ETE/Re-enlistment and Reservist
ADT/AADT Orders.
4) Surrender old AFP ID, if lost, attached AFFIDAVIT OF LOSS and POLICE BLOTTER.
If lost ID is recently issued, it will be replaced a month after filing for evaluation.

*Supporting documents/papers can be photocopied as long as original copy is presented. In the absence of
original, Authenticated copies (in original mark) by duly Authorized officers should be used. OTAG may also
require additional documents if needed to support the AFPICS application.

OTAG ADDRESS: Chief, Information Systems Division C/O Mr. Arlon T. Libot OFFICE OF THE ADJUTANT GENERAL
(OTAG) GENERAL HEADQUARTERS, AFP, CAMP GENERAL EMILIO AGUINALDO QUEZON CITY 1110
CONTACT NUMBERS: Mobile # 0905-672-3395 / 0975-795-6561 LANDLINE # (02) 8911-6001 Local 6653